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      <h1 class="post-title">公卫时评几则</h1>

      <div class="post-meta">
        <span class="post-time"> 2020-05-25 </span>
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            <a href="/categories/%E6%97%B6%E8%AF%84/"> 时评 </a>
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          <span class="more-meta"> 约 1863 字 </span>
          <span class="more-meta"> 预计阅读 4 分钟 </span>
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  <h2 class="post-toc-title">文章目录</h2>
  <div class="post-toc-content always-active">
    <nav id="TableOfContents">
  <ul>
    <li><a href="#1">1</a>
      <ul>
        <li><a href="#马后炮">马后炮</a></li>
        <li><a href="#瞎投资">瞎投资</a></li>
      </ul>
    </li>
    <li><a href="#2">2</a>
      <ul>
        <li><a href="#一种垮塌形式是技术遭到政治干预">一种垮塌形式是技术遭到政治干预</a></li>
        <li><a href="#另一种垮塌形式影响更深远">另一种垮塌形式影响更深远</a></li>
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    <div class="post-content">
      <h2 id="1">1</h2>
<h3 id="马后炮">马后炮</h3>
<p>现在很多声音都在疾呼加强公共卫生建设，马后炮震天响。悲观地说，大疫情的发生是宿命，不是新冠，也会是新新冠。</p>
<p>之前长三角成功封堵禽流感，换来了什么？高层和大众对此伟功毫无认知，疾控系统待遇持续下降，人员持续流失。非得出一次大灾，才会重新念起好。万一这次中疾控不犯浑，又给堵住了呢？大家又会继续遗忘下去，直到有经验的都退休了，剩下的菜鸟再也无力处置下一次大疫。这不是中国一家的问题，美国财政减负，也是连年带头砍CDC的预算。名言说得好，「走遍天下，公共卫生都没什么地位」。这个行当，瘟神就是财神。防住了，反而兔死狗烹；防不住，大佬会吃瓜落，但行业能得利。横竖都没好事。</p>
<p></p>
<h3 id="瞎投资">瞎投资</h3>
<p>到处在开建公卫学院了。两会提案还有建议组建国家级公卫大学的。这是典型的顺周期投资，相当于A股6000点时加仓，最后必然一地鸡毛，连熊二十年。</p>
<p>公卫的问题根本不是人才供给不足，而是人才需求长年不振。全国只有毛十所公卫学院，一年供应一千多人的时候，尚且有八成的流失率。这意味着什么？劳动力市场在用价格信号出清过剩的供给啊！等这波扩招大跃进结束，用人单位还是那么些，供给明显过剩，多出来的「人才」难道集体喝西北风去？综合大学的学生好歹还能靠学校牌头去考个会计证拼四大去，「公卫大学」这种名字就透着「特化」气息的学校，对跨界就业恐怕一点忙都帮不上。为了每一二十年一遇的大疫储备过剩的人财物，然后在缓慢的下行过程中逐步出清。这就是这个行业的残酷实质。有人可能说，这次不会重演了，我们会吸取教训的，会人尽其才物尽其用的。可拉倒吧。03年不也这么说。</p>
<h2 id="2">2</h2>
<p>如今，我们看到、听到的是一派「加强公卫建设」的呼声。这已经迈进解决方案阶段，识别问题、分析问题的环节被快速带过了。人们简单地总结说，疫情搞成这样，是因为公卫薄弱了，缺少资源和权力，所以对策很简单，针对性地做点加法。真这么简单？</p>
<p>环视世界，你会发现：</p>
<div class="admonition tip"><p class="admonition-title">真实情况是</p>
<p>作为技术官僚治理代表的经典公卫范式在世界范围内垮塌。</p>
</div>
<h3 id="一种垮塌形式是技术遭到政治干预">一种垮塌形式是技术遭到政治干预</h3>
<p>无论中国CDC还是美国CDC，这次疫情中都毫无声响。私底下干了很多活，但在关键产出上到处掉链子，话语权都丢光了。疫情之初，中国CDC被wh官府玩得团团转，信息披露举步维艰，迅速丢掉了公众信任，导致后期权威声音都从临床医生那里出。美国CDC起初在试剂盒、数据披露环节出了好多次乌龙，加上闯王作梗，女婿夺权，抗疫主导权完全丢失。在协调未知性强的大型项目时，「领导支持」是至关重要的条件之一。政治干预等于抽走了这层板，信任之塔随之倒塌，然后就没有然后了。</p>
<h3 id="另一种垮塌形式影响更深远">另一种垮塌形式影响更深远</h3>
<p><strong>那就是公卫技术范式本身的垮塌。</strong></p>
<p>中美日都可以怪政治干预，好，像英国、瑞典那样充分授权技术官员总没什么可说的了吧？结果，这些国家搞起了「群体免疫」。公平地讲，群体免疫方案的细节是很精巧的，非常符合学科精髓——卫生经济学评估。疫情本身造成的健康损失，和抗疫措施造成的健康损失，需要进行权衡。如果任何抗疫措施造成的损失，都要大于疫情本身，那不如什么都别做。这个原则看起来很正确，但事实是，抗疫造成的健康损失，主要是因为经济下滑导致的间接损失。然而什么都不做，难道经济就不下滑了吗？现在瑞典的新冠死亡率已经是第一名，虽然抗疫措施能省则省，但该有的经济损失还是一分没少。在复杂系统面前卖弄上帝视角，很容易玩崩。这就是技术官僚的傲慢所能造成的灾害。</p>
<div class="admonition note"><p class="admonition-title">关于群体免疫多喷几句</p>
<p>中国防制策略的核心并不是暴力封城，而是「阻断流动，集中收治。应检尽检，应收尽收」。虽然美国的防制措施也不那么完美，但起码开始接受这个核心原则了。英国则心存侥幸地想学日本的策略，挑挑拣拣地做防控，最后再吃一波全球防疫红利。</p>
<p>但凡心存侥幸，就大概率在侥幸环节上跌倒。英国人要么坚壁不出，死活不牺牲自我形成免疫屏障；要么跟意大利人一样陷入恐慌盲动，最后（也就一两周后的事）还是封城了事。英国的策略大概率会失败。即使侥幸成功，也是人类文明的耻辱。这个首席专家作为医生，对不起希波克拉底誓言；作为当代人，对不起康德的「人是目的，不是手段」。</p>
</div>
<p>上述两种形式的垮，本质上都是范式「市侩化」的结果。它们或被动，或主动地迎合了利于资本利害算计的体系，导致最终动作变形。饱受经济学浸泡，作为社会宏观治理一部分的公卫治理也不可避免地习惯于量化评价。问题是，<strong>人命不宜定价</strong>。（我特别反对废除死刑论的一点就是，死刑的成本比无期更高，连「不惜代价追求正义」的遮羞布都不要了，真是下作。）不深刻地反思这一点，加再多的资源，下一次碰到大规模疫情，还是会在原地跌倒。</p>
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